Predictors of survival in patients who underwent video‐assisted thoracic surgery talc pleurodesis for malignant pleural effusion

Abstract

BackgroundPatients with malignant pleural effusion have a limited life expectancy. An increase in pleural and oncological treatment options and more accurate prognostic evaluation may help individualize treatment strategies. The aim of this study was to identify the prognostic indicators of overall survival (OS) after video‐assisted thoracic surgery (VATS) talc pleurodesis for malignant pleural effusion.MethodsWe examined the medical records of all consecutive patients with malignant pleural effusion who underwent VATS talc pleurodesis from 2006 to 2008 at the Samsung Medical Center. Univariate and multivariate analyses were used to identify predictors of OS after VATS talc pleurodesis.ResultsDuring the study period, 91 patients underwent VATS talc pleurodesis to treat malignant pleural effusion. Early (within 30 days) and late (within 90 days) postoperative mortality rates were 9.9% (9 patients), and 25.3% (23), respectively. Median survival time after VATS talc pleurodesis was 10.5 months. The postoperative respiratory complication rate was 11% (10 patients), and included pneumonia (9) and acute respiratory distress syndrome (4). Multivariate analysis revealed that preoperative chemotherapy (P = 0.012), preoperative radiotherapy (P = 0.003), and Eastern Cooperative Oncology Group (ECOG) performance score 3 or 4 (P = 0.013) were independent risk factors of OS after VATS talc pleurodesis.ConclusionsWe identified previous chemotherapy or radiotherapy and poor performance status (ECOG 3 or 4) as significant predictors of OS after VATS talc pleurodesis. These prognostic factors can help surgeons select candidates for VATS pleurodesis for malignant pleural effusion.

ERS/EACTS statement on the management of malignant pleural effusions

“…However, pH could not reliably predict 3-month survival and was therefore insufficiently accurate for clinical use. Pleural fluid glucose, which is closely related to pH, was similarly non-predictive [31,41,119,126,129].…”

“…However, the authors conflated correlation with causality, and ignored potential confounding by indication in the two treatment arms. Another series of 91 patients explored factors associated with poor survival after talc poudrage [41]. Poor performance status and prior use of https://doi.org/10.1183/13993003.00349-2018 chemo/radiotherapy were adverse prognostic factors, and these clinical parameters may be helpful in triaging patients to treatments.…”

“…Pleural fluid pH may also predict survival: an early study demonstrated worse prognosis in patients with pleural fluid pH <7.2 [131]. However, whilst several subsequent studies replicated the original finding, albeit using lower pH cut-offs [31,119,129], others found no relationship between pH and survival [41,126]. Patient-level data from these studies were pooled in a meta-analysis that confirmed pH ⩽7.28 was associated with shorter survival [116].…”

“…Lymphocytes, however, are fundamental to immune-mediated cancer control and low counts result in less effective tumour destruction and worse survival [151][152][153]. The NLR combines these two variables to provide a simple prognostic value that has been shown to be accurate in many cancers [41,145,[154][155][156][157][158][159][160].…”

Is the LENT Score Already Outdated?

“…Median survival following its diagnosis is usually less than 12 months and is dependent on the type of underlying malignancy, performance status, treatment, and the characteristics of serum and pleural effusion markers [2][3][4][5]. Although lung and breast cancer are the most common causes of MPE, the prognosis for different patients with MPE varies widely, exposing the need to subcategorise MPE patients in order to tailor or individualise their treatment [6].…”